Background The association of pulmonary embolism (PE) with deep vein thrombosis (DVT) in patients with coronavirus disease 2019 (COVID-19) remains unclear, and the diagnostic accuracy of D -dimer tests for PE is unknown. Purpose To conduct meta-analysis of the study-level incidence of PE and DVT and to evaluate the diagnostic accuracy of D -dimer tests for PE from multicenter individual patient data. Materials and Methods A systematic literature search identified studies evaluating the incidence of PE or DVT in patients with COVID-19 from January 1, 2020, to June 15, 2020. These outcomes were pooled using a random-effects model and were further evaluated using metaregression analysis. The diagnostic accuracy of D -dimer tests for PE was estimated on the basis of individual patient data using the summary receiver operating characteristic curve. Results Twenty-seven studies with 3342 patients with COVID-19 were included in the analysis. The pooled incidence rates of PE and DVT were 16.5% (95% CI: 11.6, 22.9; I 2 = 0.93) and 14.8% (95% CI: 8.5, 24.5; I 2 = 0.94), respectively. PE was more frequently found in patients who were admitted to the intensive care unit (ICU) (24.7% [95% CI: 18.6, 32.1] vs 10.5% [95% CI: 5.1, 20.2] in those not admitted to the ICU) and in studies with universal screening using CT pulmonary angiography. DVT was present in 42.4% of patients with PE. D -dimer tests had an area under the receiver operating characteristic curve of 0.737 for PE, and D -dimer levels of 500 and 1000 μg/L showed high sensitivity (96% and 91%, respectively) but low specificity (10% and 24%, respectively). Conclusion Pulmonary embolism (PE) and deep vein thrombosis (DVT) occurred in 16.5% and 14.8% of patients with coronavirus disease 2019 (COVID-19), respectively, and more than half of patients with PE lacked DVT. The cutoffs of D -dimer levels used to exclude PE in preexisting guidelines seem applicable to patients with COVID-19. © RSNA, 2020 Supplemental material is available for this article. See also the editorial by Woodard in this issue.
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Intestinal ischemia in the COVID-19 era To the editor From the end of December, the world is facing the threat of a new zoonosis caused by Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS CoV-2) which gave rise to a pandemic which is currently ongoing. The Bergamo province has been one of the most affected regions worldwide with an increase in the mortality rate in the first trimester of 2020 of + 568% [1] if compared with the first trimester of the previous four years (2015-2019). Papa Giovanni XXIII Hospital was the most affected structure with over 20 0 0 admission for COVID-19 to date [2]. We describe a case of fatal intestinal infarction whit a difficult diagnosis, which was made possible throughout by using innovative technique. A 62-year-old unconscious man was admitted to the Emergency Department of Papa Giovanni XXIII Hospital (Bergamo, Italy) with severe hypotension during the month of April 2020. The recent medical history reported by phone from his wife included three days of abdominal pain and bilious vomiting. The patient's main comorbidities were obesity, arterial hypertension, diabetes mellitus type 2 and hepatic cirrhosis (non-alcoholic steatohepatitis + hepatitis B). Blood tests revealed an increase in the blood
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